Coeliac Disease

Question 1

What is coeliac disease?

Answer 1

‘Auoimmune’ - immune reaction to Gliadin fraction of wheat
HLA associated
Causes mucosal damage in the small bowel
- malabsorption - B12, Fe, Vit D, Calcium deficiency
- abdo pain
- worse after eating
- flatulence and bloating (due to malabsorption - more eg. Starch molecules stay in gut - ferment in large bowel and hold more water in bowel due to osmotic pull)
- diarrhoea
- steatorrhoea
- N+V

Question 2

What skin manifestation is associated with coeliac disease?

Answer 2

Dermatitis herpetiformis
- pruritic, burning, stinging, blistering

Skin biopsy will confirm this
Patients may have asymptomatic coeliac disease with this - always worth testing them

Question 3

What blood test can be done for coeliac disease?

Answer 3

Tissue transglutaminase antibody (IgA)
Endomysial antibody (IgA)

Duodenal Biopsy is GOLD standard but patient has to be eating gluten at time of biopsy for 6 weeks prior

Question 4

What are the histological signs of coeliac disease?

Answer 4

Villus atrophy
Hypertrophy of crypts
Lymphocyte infiltration

Question 5

What are possible complications of coeliac disease?

Answer 5

Hyposplenism (give encapsulated Bacteria vaccines)
Small bowel T cell lymphoma
Abnormal LFTs - raised ALT - hepatocellular damage
Vit deficiencies - osteomalacia